Q: I saw a tummy operation on a TV show the other day that got me reallly excited. It was a new operation called the Smooth Tuck. It was a impler way of doing a tummy tuck because no muscle repair is done and it uses a much smaller scar above the bikini line. The recovery is only one week. This sounds great! I was scheduled to have a full tummy tuck and I was dreading it. This sounds so much better. Do you think I should have this tummy procedure done instead? Is it too good to be true?
A: While I have no idea what your tummy problem is or looks like, I can make a predictive statement that it is too good to be true. The Smooth Tuck is nothing more than a mini-tummy tuck wrapped up with a slick sounding name. Whether the smooth refers to how your tummy will look after or what it is like to go through and recover from is unknown to me. And I am not saying that it is a bad operation. The key question is whether this is an operation for you. Does the solution it can provide match the size of your problem? If you are better suited to a full tummy tuck, then this lesser operation will leave you disappointed no matter how smooth it sounds. There are some tummy tuck patients who are ideally suited for this approach but it is usually only a minority of them. You understandably are interested in something that sounds easier than the traditional tummy tuck approach. Just be certain that the real limitations of this marketed operation do not leave you with the opposite of your desired result…an unsmooth tummy that should have had a different tummy tuck technique done.
Dr. Barry Eppley
Q: I’m planning on having a tummy tuck and have read that they can be done without using any drains. I don’t want a drain because it creeps me out thinking about a tube coming out of my body. I have also read that some plastic surgeons still use drains because they think it is better. What are your thoughts as to which way is best?
A: I have done tummy tucks both with and without drains. There are pluses and minuses each way which is why drain use is controversial and variable amongst different plastic surgeons. The purpose of a drain is to remove fluid that the body produces in the healing space of the tummy tuck area. When doing a tummy tuck without a drain, this open space is closed down with extra sutures which takes time and does add to the cost of the operation. Even though a drain might not be used, there is a small chance that fluid can still accumulate and have to be tapped later. When doing a tummy tuck with a drain, it will stay in for 7 to 10 days. There is about a 1/3 chance later that some fluid will still accumulate and have to be tapped.
Having done tummy tucks both ways, I have seen numerous cases where fluid still had to be tapped later whether a drain was placed or not. Unless a patient is possessed about not having a drain, I will use a drain most of the time. When a patien is opposed to a drain, I will use extensive plication sutures and extra OR time to perform it. That will add about a one-half hour to the cost of the operation.
Dr. Barry Eppley
Q: I am 28 years old and have had 2 kids. I only gained about 25 to 30 lbs with each pregnancy but I still ended up with stretch marks on my lower stomach and loose skin around my belly button. I know that liposuction alone is not the solution for my stretch marks and loose skin. I am at a fairly good weight for me being 5’ 3” and weighing 130 lbs. Which type of tummy tuck do you think would be best for me?
A: While it is impossible to give an accurate assessment without photos, your description of your abdominal concern do make for a philosphic discussion between the two types of tummy tucks. The conceptual difference between a mini- and full tummy tuck is that the more limited procedure produces less of a result (around the belly button area) but has a smaller and lower placed horizontal scar. The key question is which trade-off can you live with better…a flatter and more complete abdominal result but with a much longer and higher horizontal scar (full) or a less long lower placed horizontal scar but with some stretch marks and loose skin still left around the belly button area. (mini-) There is also a belly button scar difference as the full tummy tuck will have one and the mini-tummy tuck will not. It really comes down to which aesthetic trade-off (scar vs amount of improvement) is more important to you.
Many women will less severe lower abdominal concerns (excess tissue) do opt for a mini-tummy tuck. When combined with liposuction in the upper abdomen and around the sides of the waistline, this more limited tummy tuck approach can provide for good improvement with a very acceptable low-placed scar.
Dr. Barry Eppley
Q: I had a tummy tuck recently and as part of it my muscles were sewn back together. I was told there were several inches apart. My tummy now is very flat in the lower half but the upepr half still has somewhat of a bulge. Do you think that is because the muscles weren’t sewn up togethere this high. I am confused as I thought the whole tummy would be flat from top to bottom. What are your thoughts?
A: The purpose of sewing the vertically-oriented rectus muscles in a tummy tuck together is to help correct one part of the tummy bulging problem. How much tummy skin and fat you have makes up the other components of the bulge. This muscle sewing is usually done from just under the rib cage in the middle (top of the inverted V) the whole way down to the just above the pubic bone. But it is up to the plastic surgeon’s discretion as to whether it is beneficial to cover this entire vertical length or not. More pain after surgery comes from more muscle sewing so there is no reason to do more than is really needed. Not every patient needs the entire vertical length of the muscles swen together as tight as possible.
It is extremely common to see a different amount of improvement in the tummy bulge from that above the belly button to that below it.. The best result is seen between the belly button and the pubis because this is where the skin and fat have been completely removed and replaced with skin and fat from above. Between the rib cage and the belly button, there still may be some remaining bulge as this skin has just been pulled down and stretched but not removed. That is likely the reason you have some bulge remaining in this area, not because the muscle hasn’t been sewn back together. In thin women, this issue may not appear. But in those patients that had thicker amounts of fat under the skin in the upper abdominal area to begin with, the upper tummy area will not be as flat as the lower. This can be improved later with some liposuction to thin out the tissue thickness in this upper tummy area.
Dr. Barry Eppley